Individual
JASON E BARNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6812 STATE ROUTE 162, SUITE 120, MARYVILLE, IL 62062-8553
(618) 288-0044
(618) 288-0066
Mailing address
6812 STATE ROUTE 162, SUITE 120, MARYVILLE, IL 62062-8553
(618) 288-0044
(618) 288-0066
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036104914
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104914
—
IL
05
—
036104914004
—
IL
01
—
P00437778
RR MEDICARE
IL
Enumeration date
08/26/2005
Last updated
01/14/2013
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